PURPOSE: To determine the efficacy and tolerance to Auto Continuous Positive Airway Pressure (ACPAP) to various optimum nasal CPAP (NCPAP) levels.
METHODS: Patients diagnosed with obstructive sleep apnea syndrome that were evaluated for NCPAP titration were entered into the study. Informed consent was obtained. Patients that failed to respond to NCPAP were discarded. Patients were randomly placed on one of the three auto CPAP (ACPAP) devices chosen for this study. ACPAP was initiated randomly either at the first part of the night or the second half of the night for at least a total of two hours. The rest of the night was spent on NCPAP titration. The optimum NCPAP pressure chosen was the lowest pressure with an AHI of < 5/hr. Response to NCPAP/ACPAP was documented if the AHI was below 5/hr. and partial response was documented if the AHI was between 5 and 10/hr.
RESULTS: A total of sixty seven patients were evaluated. Optimum pressures for NCPAP ranged from 4 cm to 18 cm. Success with auto CPAP was approximately 50% with optimum NCPAP levels of 4 and 6 cm and was less than 15% with NCPAP levels of 8cm and above. ACPAP pressures were also compared to optimum NCPAP levels and correlated only 33% of time. 50% of time ACPAP levels were above 2 cm and 17% of the time ACPAP levels were below 2cm when compared to optimum NCPAP levels.
CONCLUSION: We strongly recommend that NCPAP titration be performed prior to initiation of ACPAP for patients with OSA. The basal pressure for auto CPAP should be the optimum pressure obtained using NCPAP titration. Limit on the upper level ACPAP may be necessary for patients that deteriorate on higher NCPAP levels.
CLINICAL IMPLICATIONS: ACPAP is partially responsive to patients with optimum NCPAP levels of 6 cm or below but fails to respond to optimum NCPAP at 8cm and above.
DISCLOSURE: George Thommi, No Financial Disclosure Information; No Product/Research Disclosure Information